Smoking is America's leading cause of preventable morbidity and mortality. Although effective cessation treatments exist, their overall effect is modest, and they rarely reach the high-risk, health-compromised smokers who need them most. Our goal is to develop, standardize, and pilot test a systemic, couple-focused treatment for change-resistant smokers based on the assumption that a smoker's marital and family relationships play a key role in whether he or she continues to smoke. We will test this family consultation (FAMCON) approach with physician-referred smokers who continue to use tobacco despite having symptoms of heart or lung disease or multiple risk factors for heart disease. Based on a theory of problem maintenance that emphasizes the empirically-grounded principles of ironic processes and symptom-system fit, FAMCON focuses on the immediate social context of smoking, aiming both to interrupt well- intentioned "solutions" that ironically feed back to keep smoking going, and to help clients realign important relationships in ways not organized around tobacco use. Ideally, FAMCON entails 7-10 sessions over 3 months and proceeds through preparation, quit, and consolidation phases. It is not an alternative treatment, but an adjunctive, complementary approach, designed to include collaboration with the primary-care physician and make smokers more amenable to other, evidence-based quit strategies. In addition to single-smoker couples, FAMCON targets couples with two smoking partners -- an understudied group typically excluded from joint participation in randomized clinical trials. Treatment development will proceed through a formulation stage, in which we develop a preliminary manual based on 8 couples seen by the PI and co-PI as primary therapists; a standardization stage, based on 8 additional cases, in which we revise the preliminary manual and standardizing procedures for training therapists and monitoring their adherence and competence; and an implementation stage in which we pilot test FAMCON with 24 couples treated by 6 therapists following the revised manual. The final stage of the project will be devoted to (a) evaluating consumer acceptance of FAMCON and smoking outcomes up to one year, (b) testing the change processes and principles of the model, and (c) preparing a final version of the manual for testing FAMCON in a randomized clinical trial.